title: Pediatric frontal lobe epilepsy: white matter abnormalities and cognitive impairment.
abstract: OBJECTIVE
  Cognitive impairment is frequent in children with frontal lobe epilepsy (FLE). Its etiology remains unknown. With diffusion tensor imaging, we have studied cerebral white matter properties and associations with cognitive functioning in children with FLE and healthy controls.
  
  
  METHODS
  Thirty children aged 8-13 years with FLE of unknown cause and 39 healthy age-matched controls underwent neuropsychological assessment, structural and diffusion-weighted brain MRI. Patients were grouped as cognitively impaired or unimpaired, and their white matter diffusion properties were compared with the controls.
  
  
  RESULTS
  Children with FLE had reduced apparent diffusion coefficients in various posteriorly located tract bundles, a reduced fractional anisotropy (FA) of the white matter tract between the right frontal and right occipital lobe, and smaller volumes of several collections of interlobar bundle tracts, compared with controls. The cognitively impaired patient group demonstrated significant increases in FA of the white matter of both occipital lobes, a reduced FA of white matter tract bundles between the right frontal and both left occipital lobe and subcortical white matter area, and smaller volumes of two collections of tract bundles connecting the frontal lobe with the temporal and parietal lobes, compared with controls.
  
  
  CONCLUSIONS
  Children with FLE had white matter abnormalities mainly in posterior brain regions, not confined to the area of the seizure focus. Cognitively impaired children with FLE showed the most pronounced white matter abnormalities. These possibly reflect disturbed maturation and might be part of the etiology of the cognitive impairment.
authors.affiliation: Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands; Research School for Mental Health & Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands.
authors.forename: H M H
authors.initials: HM
authors.lastname: Braakman
authors.forename: M J
authors.initials: MJ
authors.lastname: Vaessen
authors.forename: J F A
authors.initials: JF
authors.lastname: Jansen
authors.forename: M H J A
authors.initials: MH
authors.lastname: Debeij-van Hall
authors.forename: A
authors.initials: A
authors.lastname: de Louw
authors.forename: P A M
authors.initials: PA
authors.lastname: Hofman
authors.forename: J S H
authors.initials: JS
authors.lastname: Vles
authors.forename: A P
authors.initials: AP
authors.lastname: Aldenkamp
authors.forename: W H
authors.initials: WH
authors.lastname: Backes
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D016880:Anisotropy; D001921:Brain / Q000473:pathology*; D016022:Case-Control Studies; D002648:Child; D003072:Cognition Disorders / Q000150:complications* / Q000175:diagnosis / Q000209:etiology*; D038524:Diffusion Magnetic Resonance Imaging; D017034:Epilepsy, Frontal Lobe / Q000150:complications*; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000150:complications*; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D009483:Neuropsychological Tests; D010372:Pediatrics
keywords: epilepsy; neuroimaging; neuropsychology; pediatric neurology